Provider Demographics
NPI:1922331420
Name:MAGUIRE BOONSTRA INC
Entity Type:Organization
Organization Name:MAGUIRE BOONSTRA INC
Other - Org Name:ADVANCED PROSTHETICS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:MADIGAN
Authorized Official - Last Name:BOONSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:605-232-0066
Mailing Address - Street 1:355 W ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5357
Mailing Address - Country:US
Mailing Address - Phone:605-232-0066
Mailing Address - Fax:605-232-2066
Practice Address - Street 1:355 W ANCHOR DR
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5357
Practice Address - Country:US
Practice Address - Phone:605-232-0066
Practice Address - Fax:605-232-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6317430001Medicare NSC